Kentucky Model Electronic Data Interchange Trading Partner Agreement
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FAQ
Healthcare EDI software transmits details like the coordination of benefits, claims status and information, insurance data, payment data and eligibility forms among healthcare providers, professionals and institutions, clearinghouses, insurance companies and government entities like Medicare.
Whereas the 999 - Acknowledgement confirms receipt of a transaction (in this case the 837), the 277CA provides more specific information about the claims that were contained in the 837, e.g. the unique identifier assigned by the health plan to their claims (i.e. per the TR3 - the payor claim control number).
A 277 transaction may be sent in response to a previously received EDI 276 Claim Status Inquiry. A payer may use a 277 to request additional information about a submitted claim (without a 276) A payer may provide claim status information to a provider using the 277, without receiving a 276.
The VBA 834 Benefit Enrollment and Maintenance Companion Guide provides supplemental information to the Trading Partner Agreement (TPA) that exists between VBA and its electronic trading partners.
The Companion Guides are to clarify, supplement and further define specific data content requirements to be used in conjunction with, and not in place of, the X12 Technical Review Type 3 (TR3s) and National Council for Prescription Drug Programs (NCPDP) Implementation Guides for all transactions mandated by HIPAA and/ ...
The Claim Status Response (277) transaction is used to respond to a request inquiry about the status of a claim after it has been sent to a payer, whether submitted on paper or electronically. Once we return an acknowledgment that a claim has been accepted, it should be available for query as a claim status search.
The term companion guide refers to documents and related materials that are used in addition to the standard HIPAA Implementation Guides.
Our Electronic Data Interchange (EDI) Companion Guides describe specific requirements for trading partners who exchange electronic transactions directly with Blue Shield of California or Blue Shield of California Promise Health Plan.
